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Methicillin-resistant Staphylococcus aureus (MRSA) in the institutionalized older patient

  • M Eveillard (a1) and ML Joly-Guillou (a1)

Nursing homes and long-term care facilities are usually considered as reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) carriers. Actually, there are major differences in MRSA carriage between institutions, with variations from 1% to more than 30%. Overall there is a low incidence of MRSA infection in these institutions, even though carriage is associated with a higher risk of subsequent MRSA infection, with high mortality rates. The main risk factors for carriage are well known: recent hospitalization in an acute-care ward, skin wounds and recent antimicrobial therapy. Age over 75 years is also a risk factor. Residents of nursing homes and long-term care facilities pose a risk of MRSA transfer to acute-care wards, with potential consequences in terms of infection control strategy or surgical antibiotic prophylaxis. No well-designed study has identified the best strategy for MRSA control in institutions for older people and strategies that have been proposed are controversial. Studies to elucidate this would be useful, as well as studies specifically designed to identify the relative importance of different ways of MRSA transmission in these institutions (cross-transmission via healthcare workers or the environment, or direct transmission from one resident to another). Finally, a first important step towards MRSA control is a strict application of standard precautions, particularly good compliance with hand hygiene.

Corresponding author
Address for correspondence: M Eveillard, Laboratoire de Bactériologie-hygiène, CHU Angers, 4 rue Larrey, F-49000, France. Email:
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1RA Bonono . Multiple antibiotic-resistant bacteria in long-term care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000; 31: 1414–22.

2RA Garibaldi . Residential care and the elderly: the burden of infection. J Hosp Infect 1999; 43 suppl: S918.

3S Alvarez , CG Shell , TW Wooley , SL Berk , JK Smith . Nosocomial infections in long-term care facilities. J Gerontol 1988; 43: M917.

4DC Norman , SC Castle , M Cantrell . Infections in the nursing home. J Am Geriatr Soc 1987; 35: 796805.

5AC Fluit , CL Wielders , J Verhoef , FJ Schmitz . Epidemiology and susceptibility of 3051 Staphylococcus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001; 39: 3727–32.

7LJ Strausbaugh , C Jacobson , DL Sewell , S Potter , TT Ward . Methicillin-resistant Staphylococcus aureus in extended care facilities: experiences in a Veteran's Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1992; 13: 711–8.

8T Baba , F Takeuchi , M Kuroda Genome and virulence determinants of high-virulence community-acquired MRSA. Lancet 2002; 359: 1819–27.

9K Okuma , K Iwakawa , JD Turnidge Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40: 4289–94.

10F Vandenesch , T Naimi , MC Enright Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003; 9: 978–84.

11G Miller , F Perdreau-Remington , G Rieg Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Eng J Med 2005; 352: 1445–53.

15SF Bradley . Issues in the management of resistant bacteria in long-term care facilities. Infect Control Hosp Epidemiol 1999; 20: 362–6.

16SF Bradley , MS Terpenning , MA Ramsey , LT Zarins , KA Jorgensen , WS Sottile Methicillin-resistant Staphylococcus aureus: colonisation and infection in a long-term care facility. Ann Intern Med 1991; 115: 417–22.

17NS Baldwin , DF Gilpin , CM Hughes , MP Kearney , C Cardwell , MM Tunney . Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland. J Am Geriatr Soc 2009; 57: 620–6.

19M Eveillard , P Charru , P Rufat Methicillin-resistant Staphylococcus aureus carriage in a long-term care facility: hypothesis about selection and transmission. Age Ageing 2008; 37: 294–9.

20P Brugnaro , U Fedeli , G Pellizzer Clustering and risk factors of methicillin-resistant Staphylococcus aureus carriage in two Italian long-term care facilities. Infection 2009; 37: 216–21.

22A Manzur , L Gavalda , E Ruiz de Gopegui Group of the Spanish Network for Research in Infectious Diseases. Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term care facilities in Spain. Clin Microbiol Infect 2008; 14: 867–72.

25A Pop-Vicas , SL Mitchell , R Kandel , R Schreiber , EM D'agata . Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 2008; 56: 1276–80.

27G Mendelson , Y Yearmack , E Granot , J Ben-Israel , R Colodner , R Raz . Staphylococcus aureus carrier state among elderly residents of a long-term care facility. J Am Med Dir Assoc 2003; 4: 125–7.

28I Sie , M Thorstad , BM Andersen . Infection control and methicillin-resistant Staphylococcus aureus in nursing homes in Oslo. J Hosp Infect 2008; 70: 235–40.

29P Kotilainen , M Routamaa , R Peltonen Eradication of methicillin-resistant Staphylococcus aureus from health center ward and associated nursing home. Arch Intern Med 2001; 161: 859–63.

30FME Wagenlehner , KG Naber , E Bambl Management of a large healthcare-associated outbreak of Panton-Valentine leucocidin-positive methicillin-resistant Staphylococcus aureus in Germany. J Hosp Infect 2007; 67: 114–20.

32CS Smith , P Parnell , G Hodgson Are methicillin-resistant Staphylococcus aureus that produce Panton-Valentine leucocidin (PVL) found among residents of care homes? J Antimicrob Chemother 2008; 62: 968–72.

34L Mody , S Maheshwari , A Galecki , CA Kauffman , SF Bradley . Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007; 55: 1921–6.

35NP O'Sullivan , CT Keane . Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents. J Hosp Infect 2000; 45: 206–10.

36C Suetens , L Niclaes , B Jans Determinants of methicillin-resistant Staphylococcus aureus carriage in nursing homes. Age Ageing 2007; 36: 327–30.

37TD Pickering , JH Gurwitz , D Zaleznik The appropriateness of fluoroquinolone prescribing in the long-term setting. J Am Geriatr Soc 1994; 42: 2832.

38A Muller , F Mauny , D Talon Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multivariate analysis. J Antimicrob Chemother 2006; 58: 878–81.

39L Le Blanc , J Pepin , K Toulouse Fluoroquinolones and risk of methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis 2006; 12: 13981405.

40PP Cook , P Catrou , M Gooch Effect of reduction in ciprofloxacin use on prevalence of methicillin-resistant Staphylococcus aureus rates within individual units of a tertiary-care hospital. J Hosp Infect 2006; 64: 348–51.

42M Eveillard , E Mortier , E Lancien Consideration of age at admission for selective screening to identify methicillin-resistant Staphylococcus aureus carriers to control dissemination in a medical ward. Am J Infect Control 2006; 34: 108–13.

44M Eveillard , C Ernst , S Cuviller Prevalence of methicillin-resistant Staphylococcus aureus carriage at the time of admission in two acute geriatric wards. J Hosp Infect 2002; 50: 122–6.

47A Manzur , M Vidal , M Pujol Predictive factors of methicillin resistance among patients with Staphylococcus aureus bloodstream infections at hospital admission. J Hosp Infect 2007; 66: 135–41.

48M Eveillard , C Leroy , F Teissiere Impact of selective screening in the emergency department on methicillin-resistant Staphylococcus aureus control programmes. J Hosp Infect 2006; 63: 380–4.

49RR Muder , C Brennen , MM Wagener Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991; 114: 107–12.

50YL Lee , T Cesario , G Gupta Surveillance of colonization and infection with Staphylococcus aureus susceptible or resistant to methicillin in a community skilled-nursing facility. Am J Infect Control 1997; 25: 312–21.

51PL Mulhausen , LJ Harrel , M Weinberger , GG Kochersberger , JR Feussner . Contrasting methicillin-resistant Staphylococcus aureus colonisation in Veterans Affairs and community nursing homes. Am J Med 1996; 100: 2431.

52N Safdar , EA Bradley . The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 2008; 121: 310–5.

53MC Roghmann . Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia. Arch Intern Med 2000; 160: 1001–4.

54NA Rezende , HM Blumberg , BS Metzger , NM Larsen , SM Ray , JE McGowan Jr. Risk factors for methicillin resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002; 323: 117–23.

57AJ Lesse , JM Mylotte . Clinical and molecular epidemiology of nursing home-associated Staphylococcus aureus bacteremia. Am J Infect Control 2006; 34: 642–50.

58K Hiramatsu , N Aritaka , H Hanaki Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997; 350: 1670–3.

59PC Appelbaum . MRSA – the tip of the iceberg. Clin Microbiol Infect 2006; 12 (suppl 2): 310.

60HK Tiwari , MR Sen . Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India. BMC Infect Dis 2006; 6: 156.

61PC Appelbaum . Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 2007; 30: 398408.

62L Niclaes , F Buntinx , F Bunaro , E Lesaffre , J Heyrman . Consequences of MRSA carriage in nursing homes residents. Epidemiol Infect 1999; 122: 235–9.

64JM Mylotte , A Tayara . Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort. Clin Infect Dis 2003; 31: 1170–4.

65RS McClelland , VG Fowler Jr, LL Sanders Staphylococcus aureus bacteremia among elderly vs. younger adults patients: comparison of clinical features and mortality. Arch Intern Med 1999; 159: 1244–7.

66AG Jensen , CH Wachmann , F Espersen , J Scheibel , P Skinhoj , N Frimodt-Moller . Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med 2002; 162: 2532.

67SE Cosgrove , G Sakoulas , EN Perencevich , MJ Schwaber , AW Karchmer , Y Carmeli . Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36: 53–9.

68MD Sanford , AF Widmer , MJ Bale , RN Jones , RP Wenzel . Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994; 19: 1123–8.

69AP Fraise , K Mitchell , SJ O'Brien , K Oldfield , R Wise . Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiol Infect 1997; 118: 15.

70CCS Hsu . Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infect Control Hosp Epidemiol 1991; 12: 416–21.

71D Pittet , B Allegranzi , H Sax Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006; 6: 641–52.

72SJ Dancer . Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008; 8: 101–13.

73SJ Dancer , L White , C Robertson . Monitoring environmental cleanliness on two surgical wards. Int J Environ Health Res 2008; 18: 357–64.

74SJ Dancer , LF White , J Lamb , EK Girvan , C Robertson . Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009; 7: 28.

75WE Trick , RA Weinstein , PL DeMarais Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001; 49: 270–6.

76E O'Fallon , S Gautam , EM D'Agata . Colonisation with multidrug-resistant gram-negative bacteria: prolonged duration and frequent colonisation. Clin Infect Dis 2009; 48: 1375–81.

78P Minary-Dohen , P Bailly , X Bertrand , D Talon . Methicillin-resistant Staphylococcus aureus (MRSA) in rehabilitation and chronic-care facilities: what is the best strategy? BMC Geriatr 2003; 3: 5.

80KW Larssen , T Jacobsen , K Bergh , P Tvete , E Kvello , O Scheel . Outbreak of methicillin-resistant Staphylococcus aureus in two nursing homes in Central Norway. J Hosp Infect 2005; 60: 312–6.

81JC Lucet , S Chevret , I Durand-Zaleski , C Chastang , B Régnier . Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit. Arch Intern Med 2003; 163: 181–8.

83R Coello , J Jiménez , M Garcia Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994; 13: 7481.

85R Batra , AC Eziefula , D Wyncoll , J Edgeworth . Throat and rectal swabs may have an important role in MRSA screening for critically ill patients. Intensive Care Med 2008; 34: 1703–6.

86A Pan , F Domenighini , L Signorini Adherence to hand hygiene in an Italian long-term care facility. Am J Infect Control 2008; 36: 495–7.

87TT Huang , SC Wu . Evaluation of a training programme on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes. J Hosp Infect 2008; 68: 164–70.

88M Eveillard , H Hitoto , F Raymond Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes. J Hosp Infect 2009; 72: 211–7.

89JP Haas , EL Larson . Measurement of compliance with hand hygiene. J Hosp Infect 2007; 66: 614.

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